How the military match works (as of 2014)

As a graduating medical student on a military scholarship, I get a lot of questions about how military scholarships and the military match work. I plan to write another post in the near future that explains how the military scholarships work in general, but since it’s match season, let’s talk about the military match process first.

I’m going to assume that you don’t know a whole lot about the military match and explain it from square one, so please forgive me if I’m saying a lot of stuff that you already know. I figured better to explain too much than too little! I am coming from an Air Force background, so I know more of the details of the Air Force system than the Army or Navy. If something is specific to the Air Force, I will indicate that.

We will start with some terms:

NRMP: The civilian National Residency Matching Program (aka the “main match” and the SOAP or scramble), which matches students into positions at the civilian residency programs

ERAS: The Electronic Residency Application Service, the civilian residency application used by all programs. Think of this like the AMCAS service that you used to apply to medical schools. The difference between AMCAS and ERAS is that there is no “secondary” application in ERAS. Remember those 5 pages of essays that you had to write for every single school that you applied to? Not this time!

JSGME: Joint Services Graduate Medical Education. This division runs the military match, and the military residency application is submitted to them. Think of JSGME as the military equivalent of NRMP. Each service also has its own office responsible for the match.

MODS: This is the military equivalent of ERAS, where you submit your application electronically. As of 2014, all three branches which have residencies (Army, Navy, and Air Force) are using MODS. In September, you submit your application and rank list (the list of which specialties and programs you are interested in, in order of preference) into MODS.

HPERB (Air Force): The list of how many residency training slots will be available in each specialty and location that year. This is released by the Air Force Physician Education Branch in June each year. A similar list is released by the other services around the same time.

Civilian deferral/deferred: This refers to a resident on a military scholarship who has been granted permission to train in a civilian program. In deferred status, you remain an inactive reservist. You collect no military pay or benefits (though you still have an ID card and can use the commissary, etc) and you have no military obligations until you complete residency. Training in this status does not increase your military commitment after residency graduation compared to training in a military program. However, you will be paid less than a military resident (usually starting around $50k/yr for a civilian vs $70k/yr for a resident in a military program). The number of military training slots in a particular specialty tends to be pretty stable from year to year, but the number of civilian deferrals varies greatly. This means that one year it may be very easy to get a civilian deferral, and the next year it might be nearly impossible.

Civilian sponsored: I haven’t seen too many of these appear recently, but this status is a hybrid between an active duty residency and a civilian deferral. You train in a civilian program, but you are on active duty and collect full military pay and benefits. As with civilian deferral, you have no military commitments during your residency. Training in this status accrues an additional year of active duty “pay-back time” after residency per year of training. For example, if you receive a four-year scholarship and complete a 4-year residency in a civilian sponsored status, you will owe 8 years on active duty after you complete your residency.

Let’s assume that, in a given year, there are 9 military training slots and 3 civilian deferrals in your specialty of interest. So that makes 12 total people who will train in that specialty. The board, which is made up of all of the military program directors in that specialty, sits down at a big table and looks at all of the candidates. First, they decide which 12 are going to train in that specialty. Then they look at who wants to go where. Who gets what they want depends on whether your top choice program wants you, and whether you have extenuating circumstances such as a spouse in residency in a certain area, family in a certain area, etc.

So how do you get the spot that you want, whether that is in a military program or a civilian deferral? There are two basic things that you need to do. The first is that you need to be selected to train in your specialty of choice, period. To do this, you need to pass Step 1 and Step 2, obviously, but what really matters to the board is whether they want to work with you. They don’t really care about your actual Step 1 or Step 2 CK scores, or your grades. To prove that they want to work with you, you have to do military away rotations and perform well. You are required to do one military away rotation as a condition of your scholarship, but it’s a good idea to “save” your active duty tour from your third year so you can do two military away rotations (if your specialty of choice has at least two military programs in your branch of service). Interview at some of the others in person if you can. In a specialty like OB/GYN where there are only a few programs, it is a good idea to at least telephone interview everywhere. If your specialty of choice has 15 programs, you may not need to interview everywhere 🙂 Either way, you want as many people at that table rooting for you as possible.

Then it comes down to two things: whether the program that you want, wants you, and whether you have a convincing reason why you need a particular location, or a deferral. When you submit your military rank list, if you rank civilian deferral first, you have to give an explanation for why (family, etc) as part of your personal statement. If you rank it second or lower, you don’t have to explain your choice, but if you have a good reason for it, it would be wise to explain that to the military program directors during your interviews.

It is important to be aware of another idiosyncrasy of the military match. The Army and the Air Force match people to a full residency, PGY-1 (intern) through graduation. The Navy initially matches everyone to a PGY-1 (intern) year only, and you must re-apply to continue in training. The majority of interns are, instead, sent out to the fleet to serve as general medical officers (GMOs) (primary care doctors) for a few years between their intern year and their PGY-2 year. I will talk about this in more detail in another post.

Is that all clear as mud? Please feel free to post your questions and I will answer them as best I can. Also keep an eye out for the other posts in this series – I will be writing about how military scholarships work while you are in school, how to apply for military scholarships, and ways to decide if a military scholarship is the right choice for you. Thanks for reading!

14 comments

Hey, I just came across your blog about the Military Match and really appreciated you sitting down to type it all out for us. I do have a question… How does it work if you rank two specialties in the Air Force? Is this a good or a bad idea? Is that something that program directors can see and make them think you aren’t committed to the specialty? We are applying OBGYN but are considering putting FM as a back up, but I don’t want it to hurt us!

That’s a great question, Lauren! I’m not a program director, of course, so I don’t have any direct experience. As a student, I spoke to the PD in one of the extremely competitive specialties and he said they understand when people rank a “backup” specialty because the board knows that only 15-25% of the people who apply to that specialty will match. I don’t know how the backup specialties feel about this, but I will say that there are usually plenty of slots in specialties like family medicine. Ranking two highly competitive specialties (like OB/GYN and EM) is probably not a good idea. I’ve heard that the Air Force usually has 20-35 applicants for 12-20 spots, which isn’t terrible as the military match goes. It’s also worth thinking, before you rank a second specialty, about whether you would be happy if that specialty became your career. Are you ok with doing FM for the rest of your life? If so, great! If not…

Could you go more in depth with the Navy when you say: “The Navy initially matches everyone to a PGY-1 (intern) year only, and you must re-apply to continue in training. The majority of interns are, instead, sent out to the fleet to serve as general medical officers (GMOs) (primary care doctors) for a few years between their intern year and their PGY-2 year” Does this mean Navy HPSP students have to serve elsewhere before they get to start their residency?

Many, though certainly not all, Navy students have to do a GMO tour for 2-3 years between their PGY-1 (intern) year and their PGY-2 year and beyond. The proportion of students who are allowed to continue directly from PGY-1 to PGY-2 seems to vary by year and specialty, depending on the needs of the service. This is a very important difference between the Navy and the other branches of service – the Air Force sends far fewer people on GMO tours, and most people complete their residency straight through without interruption.

Quick (possibly dumb) question. I am on the Air Force HPSP and I was wondering if we are allowed to rank programs in other branches in addition to the Air Force slots? I think I was told by someone that this was an option. It just seems like it would open up many more opportunities, geographically speaking.

Hey there! I’ve received the Air Force HPSP scholarship and look forward to serving as a military physician. However, my biggest concern is sub-specialization. I know the military needs all types of physicians, but as of now, I’m interested in a few things, one being cardiology. I guess my first question is, do you know how they handle fellowships? Assuming I did an Air Force IM residency, then applied for cardiology fellowships, would it be treated like a civilian deferral? Secondly, would the military restrict my ability to apply for a fellowship if they didn’t need said specialty (assuming I was still a competitive applicant)? And lastly, what do you know about volume/caseload of the AF hospitals? I have heard outside of SAUSHEC and Walter Reed that many are quite slow.

Thanks for your question. The Air Force requires you to be selected within the JSGME match process to complete a fellowship before you can do a fellowship in any subspecialty. Review the HPERB to see how many spots there are for your subspecialty of interest, knowing that this may vary from year to year. (You can just google AF HPERB 2015, 2016, etc to get the documents.) The short answer is that yes, the Air Force can choose not to let you do a cardiology fellowship if they don’t need another cardiologist right now, regardless of how stellar your fellowship application might be.

In general, across all specialties, the military residencies tend to have a slightly lower case volume and lower acuity than most large civilian academic institutions because the military population is largely pretty young and healthy. They often compensate for that with a larger amount of time spent on formal academics, which is not necessarily a bad thing! That being said, in internal medicine you may find yourself treating a lot of retirees, with all of the usual chronic health conditions you would expect in any older population.

I’m glad the site has been helpful to you – please remember to send in any thoughts that you have while you are on your military away rotations (they will be anonymized, I promise) and feel free to keep asking questions!

Hi! On this same topic, you mention that the JSGME makes the fellowship decisions: they could let you do military fellowship, or a civilian fellowship, or no fellowship. Somewhere on the Air Force medical site, I saw that IF they allow you to do a civilian fellowship, it is your responsibility to secure that spot (meaning you have to enter the NRMP also). BUT, for 2017, the NRMP match occurred 1 week before the JSGME. So what happens if you match into a civilian program through the NRMP, but a week later the JSGME tells you no, that you have not gotten a fellowship position? The NRMP match is a binding contract! Do you have any insight on how this works?

Thanks for your question! You apply to the JGSME a year in advance of your NRMP match cycle. So in OB/GYN, for example, you apply to the JSGME the fall of your PGY-3 year, then apply to NRMP/ERAS the spring/summer of your PGY-3 year, and match in the fall NRMP match your PGY-4 year. This means you know whether the military will let you do fellowship (and whether they are providing funding for your training) before you even apply to civilian fellowship programs.

I really appreciate your blog. I’m Air Force HPSP and have just barely passing step scores but would like to do a relatively competitive specialty or at least IM. I was thinking about doing a few years in flight medicine to make myself more competitive. My fear is getting stuck in flight medicine and not being able to match into either specialty because of my low test scores. Is this something of concern. I’ve heard that doing flight medicine gets you almost anything, But I can’t help but be apprehensive when I see the step averages on the residency reports for each specialty that the Air Force sends out.

Jay, sorry for the very late response! Internal medicine is not too competitive last I checked, but of course that varies from year to year. If your step 1 score is borderline, it sounds like you will want to be sure that you do a lot better on step 2. I would also recommend that you try to do two away rotations in your specialty of choice and work your TAIL off on those rotations to show that you will be a good resident, even if you aren’t a great test-taker. If you fail to match in IM, you can certainly do a PGY-1 only, do flight medicine, and re-apply after your flight medicine commitment is over, which is said to make you more competitive in some specialties. If IM is what you want, though, I would focus on getting there instead of trying to do flight medicine right out of the gate if that isn’t what you actually want to do.

Hello – I enjoyed your website and blog – back when I was an HPSP student I think there might have been a newsletter we got in the mail from time to time, but that was it. I did HPSP from 1994 to 1998 and then did a civilian residency. I was happy with how it worked out and really liked my residency. But I didn’t seek that outcome – I applied to civilian programs as a back up because we were all told to do that in case we did not match in the military match. Then I did not match in the military match (I was surprised by this), so I was glad I participated in the civilian one. I served on active duty from 2001 to 2006 and stayed in the reserves. Fast forward to today and my quest to get retirement points. I already got credit for my med school years – 50 points per year for 4 years. During residency, all I got were my 15 participation points per year. As far as I know, there is no way to get education points for the 3 years spent in civilian residency – I wonder if you know any different. I was paid by my residency program, and had their health insurance, retirement, vacation, etc. According to the Army, I was on an educational delay, definitely not sponsored by the Army. Do you know if there is any way to get “a good year” of retirement points for an HPSP obligated IRR soldier on educational delay doing a civilian residency? If so, let me know. Thank you.